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Practice variations in managing infantile hemangiomas
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  • Thomas McLean,
  • Alexandra Borst,
  • Adrienne Hammill,
  • Ionela Iacobas,
  • Autumn Atkinson,
  • Tishi Shah,
  • Judith F. Margolin,
  • Sherry Bayliff,
  • Julie Blatt
Thomas McLean
Wake Forest University School of Medicine

Corresponding Author:[email protected]

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Alexandra Borst
The Children's Hospital of Philadelphia Research Institute
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Adrienne Hammill
Cincinnati Children's Hospital Medical Center
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Ionela Iacobas
Texas Children's Pediatrics
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Autumn Atkinson
The University of Texas Health Science Center at Houston
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Tishi Shah
Boston Children's Hospital
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Judith F. Margolin
Texas Children's Pediatrics
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Sherry Bayliff
University of Kentucky Medical Center
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Julie Blatt
University of North Carolina Research Opportunities Initiative
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Background Infantile hemangioma (IH) is the most common benign tumor of infancy. For children with IH who require treatment, propranolol and other beta blockers have been shown to be safe and effective. Although consensus guidelines for propranolol have been published, anecdotal experience suggests that there remain variations in management. This study was performed to document these variations amongst providers and to identify areas for future research. Methods We conducted an internet-based survey of clinicians who treat patients with IH. Characteristics of respondents were collected. Hypothetical cases and management scenarios were presented and respondents were ask to comment on dosing, monitoring, frequency of follow-up, duration of therapy, whether to taper or abruptly discontinue mediation, and which patients should get additional evaluation. Results Twenty-nine respondents participated in the survey: pediatric hematologists/oncologists (n= 15), pediatric cardiologists (n= 10), dermatologists (n = 2), an ophthalmologist (n = 1), and a neonatologist (n = 1). Most respondents use generic propranolol in infants with growing IH of the head and neck, with a goal dose of 2 mg/kg/day, until approximately one year of age. A variety of management strategies were documented including which patients should be treated, optimal dose and duration of therapy, how patients should be monitored, which patients should get additional work up, how propranolol should best be discontinued, and how often to see patients in follow-up. Conclusions This study demonstrates wide practice variations in managing patients with infantile hemangioma. Further research is indicated to address these variations and develop additional/updated evidence-based guidelines.